Sometimes a pineapple is just a pineapple.
But one day in January, the rough edges of the cone (and the single feather protruding from it) meant something different to Rachel Oppenheimer, 25, a counselor at the Chesapeake Mental Health Collaborative in Towson, Maryland.
“Growing up, I had some challenges,” Oppenheimer said, referring to his thorny teenage past, “some struggles managing my emotions.”
But her grandmother, who died four years ago, was soft as a feather and provided unconditional love that reminded Oppenheimer how important it was to treat herself with “comforting tenderness,” especially when she became self-critical.
Ms. Oppenheimer and her clinical supervisor, Heidi Schreiber-Pan, were visiting Talmar, a nonprofit farm that offers therapeutic programs and vocational training, a short distance from the busy highway and nondescript shopping centers near their office. On the farm, the only sounds were the babbling of a brook, the chirping of birds, and several inches of snow crunching underfoot. It was the perfect place to teach Mrs. Oppenheimer therapeutic techniques that use the natural world.
They set up camping chairs under a bright blue sky during their session (a makeshift office without walls) and discussed how to create a circular design called a mandala. Next, they arranged the objects that Ms. Oppenheimer found on the floor, each symbolizing the complex feelings that arose from grieving her grandmother.
Dr. Schreiber-Pan is one of a growing number of therapists who conduct their therapy sessions outdoors and, in some cases, train other counselors to do the same. They say combining traditional talk therapy with nature and movement can help clients feel more open, find new perspectives, and express their feelings, while also helping them connect with the outside world.
“It’s a sense of belonging to something bigger, and that’s, I think, an ‘aha!’ really powerful. moment for many people“ Dr. Schreiber-Pan said. As humans evolved, they spent much of their time outdoors, he added, but our modern lives are mostly spent indoors, looking at digital devices.
Outdoor therapy falls under the umbrella of ecotherapy, a broad and nebulous term that includes activities as varied as equine therapy and outings such as adventure and nature therapy. During the pandemic, while many therapists worked online, others held sessions outdoors, seeking a safer way to meet in person. But the concept has been around for much longer.
Decades ago, psychiatrist Dr. Thaddeus Kostrubala, author of the 1976 book “The Joy of Running,” was known for jogging with his patients. The practice was never successful, in part because most therapists They were trained to meet with clients in controlled indoor environments, to maintain confidentiality and strict boundaries.
Now, however, students are receiving ecotherapy training at some schools, including Lewis and Clark College in Oregon and Prescott College in Arizona.
And some therapists, like Dr. Schreiber-Pan, are creating their own curricula. In 2020, he founded the Center for Nature-Informed Therapy, which offers certification and continuing education credits to any certified social worker or counselor who completes the program. So far more than 100 people have graduated.
Outdoor sessions are not the same for everyone. Not all customers will want to walk in the snow, for example. Dr. Schreiber-Pan and other therapists also give clients the option to explore nature indoors, starting with a collection of shells, stones, sticks and sharp gum. And there is no special license for this therapy; There are no established best practices that dictate the exercises or activities therapists should use when meeting with clients outdoors.
Some in the field are wary of the emerging discipline. Dr. Petros Levounis, president of the American Psychiatric Association, said he would be a little “skeptical” about taking a patient to the park.
“There is a formality to psychotherapy: tried and true parameters,” he said. “You sit across from them; There is the 45 minute session. And I don’t know exactly what would happen outdoors. It starts to rain. What do you do with the patient?
Psychiatrists should think more carefully about this, he added, and consider special training “before signing on the dotted line for these types of novel interventions.”
Still, he added, several studies have found that being immersed in nature can be beneficial for mental health. TO analysis 2023 of the effects of “forest bathing,” the Japanese practice of taking a relaxing walk in the forest, suggested that it can significantly reduce symptoms of depression and anxiety. And being physically active is associated with a lower risk of depression. One review A number of studies even concluded that “physical activity should be a key approach” when managing psychological distress.
‘It connects me with the human being’
Outdoor or nature-based therapy has become a big draw for men and people under 40, Dr. Schreiber-Pan and other therapists said.
Chase Brockett, 36, who lives in Portland, Oregon, started hiking therapy in 2022 and continued for about a year and a half, despite having to pay for sessions out of pocket.
“It connects me with being human, with being alive,” he said. “Not to be subject to the world, but to be part of it.”
During his sessions, he and his therapist, Aimee Frazier, would go out in all types of weather, including rain.
“You have to be uncomfortable and just accept that that’s what’s happening,” he said, a lesson that became an analogy for his anxiety. “I think a lot of anxiety comes from A) seeing anxiety as a bad thing and B) trying to escape it at all times,” she said.
Therapists also see other benefits: more receptive and relaxed clients.
“I think for some young people, therapy seems very prescribed,” said Andrew Tepper, founder of Boda Therapy, who often works with teens and young adults in New York City and the Catskills. “It’s a lane. Ah, let’s sit down. Let’s talk and maybe play a board game. And I think that comes with some resistance.”
Tepper, a psychotherapist, guides his clients toward outdoor movement (walking or skiing) if they are receptive to it. During a retreat in early February, he took three clients snowshoeing, went on long hikes, and cooked lunch over a campfire.
“I think therapy can be fun, and part of that is doing a little initial assessment of what your clients like to do,” she said.
‘I started to feel like the withered plant in my office’
Therapists are finding that a nature-based practice can improve their own well-being and also help avoid professional burnout.
Years ago, when Ms. Frazier finished a clinical internship in a dimly lit, windowless office, she realized she needed a “more lively environment,” for her clients and for herself.
“I started to feel like the wilting plant in my office that was in a dark corner,” he said. “I longed to be in the sun and rain, surrounded by the calming presence of nature.”
In 2021, he began offering hiking therapy to clients under the supervision of Thomas J. Doherty, a Portland psychologist who founded the ecotherapy certificate program at Lewis and Clark College. For some clients, he said, the environment makes therapy more accessible and less intimidating.
Maria Nazarian, a clinical psychologist in Santa Monica, California, doesn’t rent an office. She only sees her clients virtually or while she walks on the beach, which she described as her “happy place.” And, she said, her clients have benefited from getting off the couch.
Walking side by side promotes collaboration, Dr. Nazarian said, and being on the shore often brings moments of wonder and awe, both of which help build “connection and trust.”
“Winter has to come”
Amy Fuggi, 63, has been seeing Dr. Schreiber-Pan on and off for six years to cope with the grief of her mother’s death.
“You want to push it away, you want to bury it, you want to ignore it,” he said. “But that doesn’t work very well.”
While outside, he said, he feels a “great connection” with his mother, who loved being outdoors and often planned camping trips for Fuggi and his siblings.
“I feel like she walks with me,” Fuggi said.
On a recent sunny Monday, she and Dr. Schreiber-Pan walked through the snow to visit a nearby college campus and disappeared onto a wooded trail near a small pond, where they played with the concept of wintering: the ability to lean into the dark times of our lives.
“They have a purpose, you know, just like winter has to happen so we can enjoy spring,” Dr. Schreiber-Pan said.
After the session, Mrs. Fuggi said she felt lighter.
“When you walk, you have fresh air and all this openness” she said. “It’s very easy to just relax and talk about things.”
Rosem Morton contributed reporting to this story.